Four Square Step Test

Assess your patient’s dynamic balance and coordination with the Four Square Step Test (FSST). Click here to get a free template and guide!

By Patricia Buenaventura on Aug 2, 2025.

Fact Checked by Nate Lacson.

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What is a Four Square Step Test (FSST)?

A or FSST is an effective tool practitioners use to measure their patient’s balance, coordination, dynamic stability, mobility, and fall risk. To assess, patients are required to step over a cane or rod while moving forward, sideways, and backward. It is one of the quickest and most reliable tests used by practitioners for older patients, those with vestibular disorders, stroke, and more.

Though there exist diagrams and videos of how to conduct the Four Square Step Test (FSST), currently, there aren’t any standardized templates practitioners can use as a reference, guide, or document where they can record a patient’s results.

Given this, for your ease and benefit, we’ve produced a Four Square Step Test (FSST) template for free download and use. In it, you can find the following:

Basic information such as the date of examination, patient name, and the examiner’s name
A diagram and directions on how to conduct the test
An allocated space where you can write the results and additional notes you may have

Is the Four Square Step Test (FSST) helpful for your practice? Want a copy of our template? Keep reading for more details and a step-by-step on downloading and using our template.

Four Square Step Test Template

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How does this Four Square Steps Test work?

Step One. Download the Template

Access and download our template by doing either of the following:

Click the “Download Template” or “Use this template” button above
Search for “Four Square Steps Test” in Carepatron’s template library on our website or app

Step Two. Conduct the Test

Before you start, don’t forget to fill out the basic information needed, such as the examination date, patient name, and your name. To add, it’s best to prepare and set up the required equipment: a stopwatch and 4 canes or rods. Feel free to check our template to know how to arrange the canes on the floor for the test.

Once everything has been prepared, you may conduct the test by following the instructions provided on the template. For good measure, we’ve also written the directions below.

Instructions: Explain that the goal is to step from one square to another, clockwise (1 to 2 to 3 to 4), then counterclockwise (4 to 3 to 2 to 1 OR 5 to 6 to 7 to 8 ), as fast as possible without touching the sticks. Both feet must touch the floor in each square and face forward the whole time if possible.

Step Three. Score

Since this test must be done twice, remember to write down the results you get from each test. The final score will be the one with the better time.

Step Four. Interpret the Results

When you have a final score, you can proceed with interpretation. If you need assistance interpreting the results, refer to the “Four Square Step Scoring” or FAQ section below.

Four Square Step Scoring

To obtain the final Four Square Step Test score, you must first record the time (in seconds) of the first and the second go. Afterward, the one with the better time - shorter time - will be your final score.

When to use this Four Square Step assessment?

Practitioners who need a foundation document, those who want to track progress, or train their patient’s balance, can utilize this Four Square Step assessment. More specifically, practitioners who are caring for the following patients:

Geriatric
Those who experienced or are rehabilitating from a stroke
Those who have Parkinson’s or vestibular disorders
Those who rehabilitating from limb weakness or limb loss

Who are these Four Square Step Test PDF for?

This test is for any practitioner caring for the patients mentioned above.

To be more specific, the practitioners who will benefit from having a PDF copy of the Four Square Step test are:

Geriatricians or geriatric doctors
Neurologists
Vascular Neurologists
Physicians
Physiologists
Physical Therapists
Occupational Therapists

Benefits of the Free Four Square Step Test

Quick and Inexpensive

Since this test only requires three pieces of equipment, a stopwatch, and 2 canes or rods, and can be administered in not more than 5 minutes, it can be considered a quick and inexpensive yet still reliable way to assess your patient’s balance, dynamic stability, etc.

Written Copies for Reference

As mentioned above, this test doesn’t have a standardized template. Therefore, our template will be useful, especially if you need a written guide, reference, or document to record your patient’s results.

Tracks Progress

There’s no cap or maximum number of times you can conduct the test. You are free to use it to track progress, compare the change between pre-treatment and during treatment, or see the difference and effectiveness between two treatment plans.

Versatile

This test wasn’t designed with a specific practitioner in mind, making it versatile for practitioners who may need it for their practice. Furthermore, our template, in particular, is just as versatile because you can easily edit it according to your wants and needs right on Carepatron.

Fully Digital and Accessible

You can download our template on any gadget you have on hand and fill it up using any local PDF editor or right on Carepatron. Even better, if you store the template on Carepatron as well, you’ll be able to give and limit viewing access to relevant parties only.

Commonly asked questions

If negative is equivalent to a failed test, a test has a negative result if the patient fails to do the test even after two attempts. The interpretation of this result is that the patient has an increased risk of falls.

On the other hand, a positive test doesn’t only mean that the patient was able to do the test successfully but they must also be able to complete the test in less than 15 seconds without assistance. The interpretation then of this result is that they are not at risk for falls.

To perform the Four Square Step Test, you will only need to prepare the set-up, equipment, and template for a guide on how to conduct the test. For a more comprehensive step-by-step, please refer to the “How does this Four Square Step Test” work section above.

Dite and Temple developed the Four Square Step Test.